UB-04 (1560) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
2
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
27
LENGTH
24
SHORT DESCRIPTION
Pay-to Provider Name (FL-2/1)
